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Bastos Gonçalves F, Mees B, Tulamo R. ESVS Guidelines App: Bringing Evidence Based Vascular Practice to your Pocket. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00254-5. [PMID: 38485048 DOI: 10.1016/j.ejvs.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Frederico Bastos Gonçalves
- Hospital de Santa Marta, Unidade Local de Saúde São José, Centro Clínico; Académico de Lisboa, Lisbon, Portugal; NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal; Hospital CUF Tejo, Lisbon, Portugal.
| | - Barend Mees
- Department of Vascular Surgery, Maastricht UMC, Maastricht, The Netherlands
| | - Riikka Tulamo
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Rakemaa L, Aho PS, Tulamo R, Laine MT, Laukontaus SJ, Hakovirta H, Venermo M. Ultrasound Surveillance is Feasible After Endovascular Aneurysm Repair. Ann Vasc Surg 2024; 100:223-232. [PMID: 37926137 DOI: 10.1016/j.avsg.2023.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Surveillance after endovascular aneurysm repair (EVAR) is traditionally done with computed tomography angiography (CTA) scans that exposes patient to radiation, nephrotoxic contrast media, and potentially increased risk for cancer. Ultrasound (US) is less labor intensive and expensive and might thus provide a good alternative for CTA surveillance. The aim of this study was to evaluate in real-life patient cohorts whether US is able to detect post-EVAR aneurysm-related complications similarly to CTA. METHODS This retrospective study compared the outcome of consecutive patients who underwent EVAR for intact abdominal aortic aneurysm and were surveilled solely by CTA (CTA-only cohort, n = 168) in 2000-2010 or by combined CTA and US (CTA/US cohort, n = 300) in 2011-2016, as a standard surveillance protocol in the department of vascular surgery, Helsinki University Hospital. The CTA-only patients were imaged at 1, 3, and 12 months and annually thereafter. The CTA/US patients were imaged with CTA at 3 and 12 months, US at 6 months and annually thereafter. If there were suspicion of >5 mm aneurysm growth, CTA scan was performed. The patients were reviewed for imaging data, reinterventions, aneurysm ruptures, and death until December 2018. The 2 groups were compared for secondary rupture, aneurysm-related and cancer-related death, reintervention related to abdominal aortic aneurysm, and maximum aneurysm diameter increase ≥5 mm. The mean follow-up in the CTA-only cohort was 67 months and in CTA/US cohort 43 months. RESULTS The 2 cohorts were alike for basic characteristics and for the mean aneurysm diameter. The total number of CT scans for detecting aneurysm was 84.1/100 patient years in the CTA-only cohort compared to 74.5/100 patient years for US/CTA cohort. Forty percent of patients under combined CTA/US surveillance received 1 or more additional CTA scans. The 2 cohorts did not differ for 1-year, 5-year and 8-year freedom from aneurysm related death, secondary sac rupture, nor the incidence of rupture preventing interventions. CONCLUSIONS Based on the follow-up data of this real-life cohort of 468 patients, combined surveillance with US and additional CTA either per protocol or due to suspicion of aneurysm-related complications had comparable outcome with sole CTA-surveillance. Thus, US can be considered a reasonable alternative for the CTA. However, our study showed also that the need of additional CTAs due to suspicion of endoleak or aneurysm nonrelated reasons is substantial.
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Affiliation(s)
- Lotta Rakemaa
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Pekka S Aho
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Riikka Tulamo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Matti T Laine
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Sani J Laukontaus
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Harri Hakovirta
- Department of Vascular Surgery, University of Turku and Turku University Hospital, Turku, Varsinais-Suomi, Finland; Department of Surgery, Satasairaala Hospital, Pori, Satakunta, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland.
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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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Niemann A, Tulamo R, Netti E, Preim B, Berg P, Cebral J, Robertson A, Saalfeld S. Multimodal exploration of the intracranial aneurysm wall. Int J Comput Assist Radiol Surg 2023; 18:2243-2252. [PMID: 36877287 PMCID: PMC10480333 DOI: 10.1007/s11548-023-02850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/02/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Intracranial aneurysms (IAs) are pathological changes of the intracranial vessel wall, although clinical image data can only show the vessel lumen. Histology can provide wall information but is typically restricted to ex vivo 2D slices where the shape of the tissue is altered. METHODS We developed a visual exploration pipeline for a comprehensive view of an IA. We extract multimodal information (like stain classification and segmentation of histologic images) and combine them via 2D to 3D mapping and virtual inflation of deformed tissue. Histological data, including four stains, micro-CT data and segmented calcifications as well as hemodynamic information like wall shear stress (WSS), are combined with the 3D model of the resected aneurysm. RESULTS Calcifications were mostly present in the tissue part with increased WSS. In the 3D model, an area of increased wall thickness was identified and correlated to histology, where the Oil red O (ORO) stained images showed a lipid accumulation and the alpha-smooth muscle actin (aSMA) stained images showed a slight loss of muscle cells. CONCLUSION Our visual exploration pipeline combines multimodal information about the aneurysm wall to improve the understanding of wall changes and IA development. The user can identify regions and correlate how hemodynamic forces, e.g. WSS, are reflected by histological structures of the vessel wall, wall thickness and calcifications.
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Affiliation(s)
- Annika Niemann
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
- STIMULATE Research Campus, Magdeburg, Germany
| | - Riikka Tulamo
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eliisa Netti
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
- STIMULATE Research Campus, Magdeburg, Germany
| | - Philipp Berg
- STIMULATE Research Campus, Magdeburg, Germany
- Department of Medical Engineering, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Juan Cebral
- Computational Hemodynamics Lab, Georg Mason University, Fairfax, USA
| | - Anne Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, USA
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany.
- STIMULATE Research Campus, Magdeburg, Germany.
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Jahromi BR, Zamotin V, Code C, Netti E, Lorey MB, Alitalo K, Öörni K, Laakso A, Tulamo R, Niemelä M. Immunoliposomes for detection of rupture-prone intracranial aneurysms. Acta Neurochir (Wien) 2023; 165:3353-3360. [PMID: 37749289 PMCID: PMC10624708 DOI: 10.1007/s00701-023-05770-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND It is estimated that significant (3.2%) of population carries intracranial aneurysm (IA). An increasing number of imaging studies have caused that the chance of finding an incidental aneurysm is becoming more common. Since IA rupture causes subarachnoidal hemorrhage (SAH) and have significant mortality and morbidity prophylactic treatment should be considered when IA is detected. The benefit and risk of treatment of IA is based on epidemiological estimate which takes account patient and aneurysm characteristics. However we know that aneurysm rupture is biological process where inflammation of aneurysm wall is actively leading to degeneration of aneurysm wall and finally weakens it until it bursts. Until now, there have not been imaging method to detect inflammatory process of aneurysm wall METHODS: We created targeting immunoliposome for use in the imaging of aneurysm. Immunoliposome comprises antibodies against at least one vascular inflammatory marker associated with aneurysm inflammation and a label and/or a contrast agent. RESULTS Histological analysis of IAs where immunoliposome comprises antibodies against vascular inflammation with a label shows promising results for selectively detecting aneurysms inflammation. In magnetic resonance imaging (MRI) we were able to detect immunoliposomes carrying gadolinium. CONCLUSION Our work opens a new avenue for using contrast labeled immunoliposomes for detecting rupture-prone aneurysms. Immunoliposomes can cary gadolinium and selectively bind to inflammatory section of aneurysm that can be detected with MRI. Further research is needed to develop immunoliposomes to be used with MRI in humans to target treatment to those patients who benefit from it the most.
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Affiliation(s)
- Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, 00260, Helsinki, Finland.
- Neurosurgery Research Group, Biomedicum Helsinki, Helsinki, Finland.
| | - Vladimir Zamotin
- Neurosurgery Research Group, Biomedicum Helsinki, Helsinki, Finland
| | - Christian Code
- PHYLIFE: Physical Life Science, Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense M, Odense, Denmark
| | - Eliisa Netti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, 00260, Helsinki, Finland
- Neurosurgery Research Group, Biomedicum Helsinki, Helsinki, Finland
| | - Martina B Lorey
- Wihuri Research Institute, Biomedicum Helsinki, Haartmaninkatu 8, Helsinki, Finland
| | - Kari Alitalo
- Wihuri Research Institute, Biomedicum Helsinki, Haartmaninkatu 8, Helsinki, Finland
| | - Katariina Öörni
- Wihuri Research Institute, Biomedicum Helsinki, Haartmaninkatu 8, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, 00260, Helsinki, Finland
- Neurosurgery Research Group, Biomedicum Helsinki, Helsinki, Finland
| | - Riikka Tulamo
- Neurosurgery Research Group, Biomedicum Helsinki, Helsinki, Finland
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, 00260, Helsinki, Finland
- Neurosurgery Research Group, Biomedicum Helsinki, Helsinki, Finland
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Zimmermann M, Larena-Avellaneda A, Rother U, Lareyre F, Søgaard M, Tulamo R, Venermo M, Behrendt CA. Editor's Choice - Long Term Outcomes After Invasive Treatment of Carotid Artery Stenosis: a Longitudinal Study of German Health Insurance Claims. Eur J Vasc Endovasc Surg 2023; 66:493-500. [PMID: 37490978 DOI: 10.1016/j.ejvs.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/23/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE There is a paucity of observational data including long term outcomes after invasive treatment for carotid artery stenosis. METHODS This retrospective study used nationwide insurance claims from the third largest provider in Germany, DAK-Gesundheit. Patients who underwent inpatient carotid endarterectomy (CEA) or carotid artery stenting (CAS) between 1 January 2008 and 31 May 2017 were included. The Elixhauser comorbidity scores from longitudinally linked hospital episodes were used. Kaplan-Meier analysis and the log rank test were used to determine long term stroke free survival. Multivariable regression models were developed to adjust for confounding. RESULTS A total of 22 637 individual patients (41.6% female, median age 72.5 years) were included, of whom 15 005 (66.3%) were asymptomatic and 17 955 (79.3%) underwent CEA. After a median of 48 months, 5 504 any stroke or death events were registered. The mortality rate varied between 0.4% (CEA for asymptomatic stenosis) and 2.1% (urgent CAS for acute stroke patients) at 30 days, and between 4.1% and 8.4% at one year, respectively. The rate for any stroke varied between 0.6% (CEA for asymptomatic stenosis) and 2.5% (CAS for symptomatic patients) at 30 days, and between 2.5% and 6.4% at one year, respectively. The combined rate for any stroke and mortality at one year was 6.3% (CEA for asymptomatic stenosis), 8.7% (CAS for asymptomatic stenosis), and 12.5% (urgent CAS for acute stroke patients). After five years, the overall stroke rate was 7.4% after CEA and 9.0% after CAS. In adjusted analyses, both older age and van Walraven comorbidity score were associated with events, while treatment of asymptomatic stenosis was associated with lower event rates. CONCLUSION The current study revealed striking differences between previous landmark trials and real world practice. It further suggested excess deaths among invasively treated asymptomatic patients.
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Affiliation(s)
| | - Axel Larena-Avellaneda
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Altona, Asklepios Medical School, Hamburg, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes-Juan-les-Pins, Antibes, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Méditerranéen de Médecine Moléculaire (C3M), Université Côte d'Azur, Nice, France
| | - Mette Søgaard
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Riikka Tulamo
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany; Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
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Lareyre F, Chaudhuri A, Behrendt CA, Pouhin A, Teraa M, Boyle JR, Tulamo R, Raffort J. Artificial intelligence-based predictive models in vascular diseases. Semin Vasc Surg 2023; 36:440-447. [PMID: 37863618 DOI: 10.1053/j.semvascsurg.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/24/2023] [Accepted: 05/24/2023] [Indexed: 10/22/2023]
Abstract
Cardiovascular disease represents a source of major health problems worldwide, and although medical and technical advances have been achieved, they are still associated with high morbidity and mortality rates. Personalized medicine would benefit from novel tools to better predict individual prognosis and outcomes after intervention. Artificial intelligence (AI) has brought new insights to cardiovascular medicine, especially with the use of machine learning techniques that allow the identification of hidden patterns and complex associations in health data without any a priori assumptions. This review provides an overview on the use of artificial intelligence-based prediction models in vascular diseases, specifically focusing on aortic aneurysm, lower extremity arterial disease, and carotid stenosis. Potential benefits include the development of precision medicine in patients with vascular diseases. In addition, the main challenges that remain to be overcome to integrate artificial intelligence-based predictive models in clinical practice are discussed.
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Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France; Université Côte d'Azur, INSERM U1065, C3M, Nice, France
| | - Arindam Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Christian-Alexander Behrendt
- Brandenburg Medical School Theodor-Fontane, Neuruppin, Germany; Department of Vascular and Endovascular Surgery, Asklepios Medical School Hamburg, Asklepios Clinic Wandsbek, Hamburg, Germany
| | - Alexandre Pouhin
- Division of Vascular Surgery, Dijon University Hospital, Dijon, France
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Riikka Tulamo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juliette Raffort
- Université Côte d'Azur, INSERM U1065, C3M, Nice, France; Institute 3IA Côte d'Azur, Université Côte d'Azur, France; Clinical Chemistry Laboratory, University Hospital of Nice, France.
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Twine CP, Kakkos SK, Aboyans V, Baumgartner I, Behrendt CA, Bellmunt-Montoya S, Jilma B, Nordanstig J, Saratzis A, Reekers JA, Zlatanovic P, Antoniou GA, de Borst GJ, Bastos Gonçalves F, Chakfé N, Coscas R, Dias NV, Hinchliffe RJ, Kolh P, Lindholt JS, Mees BME, Resch TA, Trimarchi S, Tulamo R, Vermassen FEG, Wanhainen A, Koncar I, Fitridge R, Matsagkas M, Valgimigli M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases. Eur J Vasc Endovasc Surg 2023; 65:627-689. [PMID: 37019274 DOI: 10.1016/j.ejvs.2023.03.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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Väärämäki S, Viitala H, Laukontaus S, Uurto I, Björkman P, Tulamo R, Aho P, Laine M, Suominen V, Venermo M. Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2023; 65:264-270. [PMID: 36334900 DOI: 10.1016/j.ejvs.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/05/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A type II endoleak is the most common complication during surveillance after endovascular aneurysm repair (EVAR), and a patent inferior mesenteric artery (IMA) is a known risk factor for an endoleak. The effect of routine IMA embolisation prior to EVAR on overall outcome is unknown. The aim of the study was to compare two strategies: routine attempted IMA embolisation prior to EVAR (strategy in centre A) and leaving the IMA untouched (strategy in centre B). METHODS Patients were treated with EVAR in two centres during the period 2005 - 2015, and the data were reviewed retrospectively. The primary endpoints were re-intervention rate due to type II endoleaks and the late IMA embolisation rate. Secondary endpoints included EVAR related re-intervention, sac enlargement, aneurysm rupture, and open conversion rates. RESULTS Strategy A was used to treat 395 patients. The IMA was patent in 268 (67.8%) patients, and embolisation was performed in 164 (41.5%). The corresponding figures for strategy B were 337 patients with 279 (82.8%) patent IMAs, two (0.6%) of which were embolised. The mean duration of follow up was 70 months for strategy A and 68.2 months for strategy B. The re-intervention rates due to a type II endoleak were 12.9% and 10.4%, respectively (p = .29), with no significant difference in the rate of re-interventions to occlude a patent IMA (2.0% and 4.7%, respectively; p = .039). The EVAR related re-intervention rate was similar, regardless of strategy (24.1% and 24.6%, respectively; p = .93). Significant sac enlargement was seen in 20.3% of cases treated with strategy A and in 19.6% treated with strategy B (p = .82). The rupture and conversion rates were 2.5% and 2.1% (p = .69) and 1.0% and 1.5% (p = .40), respectively. CONCLUSION The strategy of routinely embolising the IMA does not seem to yield any significant clinical benefit and should therefore be abandoned.
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Affiliation(s)
- Suvi Väärämäki
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland.
| | - Herman Viitala
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sani Laukontaus
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Uurto
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Patrick Björkman
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riikka Tulamo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Aho
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Laine
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Velipekka Suominen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Naylor R, Rantner B, Ancetti S, de Borst GJ, De Carlo M, Halliday A, Kakkos SK, Markus HS, McCabe DJH, Sillesen H, van den Berg JC, Vega de Ceniga M, Venermo MA, Vermassen FEG, Esvs Guidelines Committee, Antoniou GA, Bastos Goncalves F, Bjorck M, Chakfe N, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kolh P, Koncar IB, Lindholt JS, Mees BME, Resch TA, Trimarchi S, Tulamo R, Twine CP, Wanhainen A, Document Reviewers, Bellmunt-Montoya S, Bulbulia R, Darling RC, Eckstein HH, Giannoukas A, Koelemay MJW, Lindström D, Schermerhorn M, Stone DH. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg 2023; 65:7-111. [PMID: 35598721 DOI: 10.1016/j.ejvs.2022.04.011] [Citation(s) in RCA: 158] [Impact Index Per Article: 158.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 01/17/2023]
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13
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Jahromi BR, Dashti R, Rustemi O, Silva JM, Srinivasan VM, Tulamo R, Kozyrev DA, Jauhiainen S, Magnuson PU, Arce M, Kaukovalta H, Schwartz C, Numminen J, Sarpaneva S, Hirvelä V, Lawton MT, Tanikawa R, Niemelä M, Hernesniemi J. Slow-Closing Clip for the Treatment of Nonsaccular Vertebrobasilar Aneurysms: A Retrospective Case Series. World Neurosurg 2022; 168:e645-e665. [DOI: 10.1016/j.wneu.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
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14
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Huuska N, Netti E, Lehti S, Kovanen PT, Niemelä M, Tulamo R. Lymphatic vessels are present in human saccular intracranial aneurysms. Acta Neuropathol Commun 2022; 10:130. [PMID: 36064651 PMCID: PMC9446758 DOI: 10.1186/s40478-022-01430-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
Saccular intracranial aneurysm (sIA) rupture leads to subarachnoid haemorrhage and is preceded by chronic inflammation and atherosclerotic changes of the sIA wall. Increased lymphangiogenesis has been detected in atherosclerotic extracranial arteries and in abdominal aortic aneurysms, but the presence of lymphatic vessels in sIAs has remained unexplored. Here we studied the presence of lymphatic vessels in 36 intraoperatively resected sIAs (16 unruptured and 20 ruptured), using immunohistochemical and immunofluorescence stainings for lymphatic endothelial cell (LEC) markers. Of these LEC-markers, both extracellular and intracellular LYVE-1-, podoplanin-, VEGFR-3-, and Prox1-positive stainings were detected in 83%, 94%, 100%, and 72% of the 36 sIA walls, respectively. Lymphatic vessels were identified as ring-shaped structures positive for one or more of the LEC markers. Of the sIAs, 78% contained lymphatic vessels positive for at least one LEC marker. The presence of LECs and lymphatic vessels were associated with the number of CD68+ and CD163+ cells in the sIA walls, and with the expression of inflammation indicators such as serum amyloid A, myeloperoxidase, and cyclo-oxygenase 2, with the presence of a thrombus, and with the sIA wall rupture. Large areas of VEGFR-3 and α-smooth muscle actin (αSMA) double-positive cells were detected in medial parts of the sIA walls. Also, a few podoplanin and αSMA double-positive cells were discovered. In addition, LYVE-1 and CD68 double-positive cells were detected in the sIA walls and in the thrombus revealing that certain CD68+ macrophages are capable of expressing LEC markers. This study demonstrates for the first time the presence of lymphatic vessels in human sIA walls. Further studies are needed to understand the role of lymphatic vessels in the pathogenesis of sIA.
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Affiliation(s)
- Nora Huuska
- Neurosurgery Research Group, Room B410b, Biomedicum 1, Haartmaninkatu 8, 00290, Helsinki, Finland.
| | - Eliisa Netti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Satu Lehti
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, 40700, Jyväskylä, Finland
| | - Petri T Kovanen
- Atherosclerosis Research Laboratory, Wihuri Research Institute, Haartmaninkatu 8, Biomedicum 1, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Riikka Tulamo
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
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15
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Morel S, Hostettler IC, Spinner GR, Bourcier R, Pera J, Meling TR, Alg VS, Houlden H, Bakker MK, van’t Hof F, Rinkel GJE, Foroud T, Lai D, Moomaw CJ, Worrall BB, Caroff J, Constant-dits-Beaufils P, Karakachoff M, Rimbert A, Rouchaud A, Gaal-Paavola EI, Kaukovalta H, Kivisaari R, Laakso A, Jahromi BR, Tulamo R, Friedrich CM, Dauvillier J, Hirsch S, Isidor N, Kulcsàr Z, Lövblad KO, Martin O, Machi P, Mendes Pereira V, Rüfenacht D, Schaller K, Schilling S, Slowik A, Jaaskelainen JE, von und zu Fraunberg M, Jiménez-Conde J, Cuadrado-Godia E, Soriano-Tárraga C, Millwood IY, Walters RG, Kim H, Redon R, Ko NU, Rouleau GA, Lindgren A, Niemelä M, Desal H, Woo D, Broderick JP, Werring DJ, Ruigrok YM, Bijlenga P. Intracranial Aneurysm Classifier Using Phenotypic Factors: An International Pooled Analysis. J Pers Med 2022; 12:jpm12091410. [PMID: 36143196 PMCID: PMC9501769 DOI: 10.3390/jpm12091410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/02/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making.
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Affiliation(s)
- Sandrine Morel
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Isabel C. Hostettler
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Neurosurgery, Canton Hospital St. Gallen, 9000 St. Gallen, Switzerland
| | - Georg R. Spinner
- ZHAW School of Life Sciences and Facility Management, 8820 Wädenswil, Switzerland
| | - Romain Bourcier
- Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), University Hospital Centre Nantes, University of Nantes, L’institut Du Thorax, 44007 Nantes, France
- Department of Neuroradiology, University Hospital of Nantes, 44000 Nantes, France
| | - Joanna Pera
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, ul. Botaniczna 3, 31-503 Krakow, Poland
| | - Torstein R. Meling
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Varinder S. Alg
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Henry Houlden
- Neurogenetics Laboratory, The National Hospital of Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Mark K. Bakker
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Femke van’t Hof
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Gabriel J. E. Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Dongbing Lai
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Charles J. Moomaw
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Bradford B. Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Jildaz Caroff
- Department of Interventional Neuroradiology—NEURI Brain Vascular Center, Bicêtre Hospital, APHP, 94270 Le Kremlin Bicêtre, France
| | - Pacôme Constant-dits-Beaufils
- Institut national de la santé et de la recherche médicale (INSERM), CIC 1413, Clinique des Données, University Hospital Centre Nantes, 44000 Nantes, France
| | - Matilde Karakachoff
- Institut national de la santé et de la recherche médicale (INSERM), CIC 1413, Clinique des Données, University Hospital Centre Nantes, 44000 Nantes, France
| | - Antoine Rimbert
- Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), University Hospital Centre Nantes, University of Nantes, L’institut Du Thorax, 44007 Nantes, France
| | - Aymeric Rouchaud
- Department of Neuroradiology, Dupuytren University Hospital, 87000 Limoges, France
| | - Emilia I. Gaal-Paavola
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, 00260 Helsinki, Finland
- Clinical Neurosciences, University of Helsinki, Topeliuksenkatu 5, 00260 Helsinki, Finland
| | - Hanna Kaukovalta
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, 00260 Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, 00260 Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, 00260 Helsinki, Finland
- Neurosurgery Research Group, Biomedicum, 00290 Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, 00260 Helsinki, Finland
- Neurosurgery Research Group, Biomedicum, 00290 Helsinki, Finland
| | - Riikka Tulamo
- Neurosurgery Research Group, Biomedicum, 00290 Helsinki, Finland
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Christoph M. Friedrich
- Department of Computer Science, University of Applied Science and Arts, 44139 Dortmund, Germany
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45147 Essen, Germany
| | | | - Sven Hirsch
- ZHAW School of Life Sciences and Facility Management, 8820 Wädenswil, Switzerland
| | - Nathalie Isidor
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Zolt Kulcsàr
- Diagnostic and Interventional, Department of Diagnostics, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Karl O. Lövblad
- Diagnostic and Interventional, Department of Diagnostics, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Olivier Martin
- SIB Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Paolo Machi
- Diagnostic and Interventional, Department of Diagnostics, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | | | - Karl Schaller
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Sabine Schilling
- ZHAW School of Life Sciences and Facility Management, 8820 Wädenswil, Switzerland
- Lucerne School of Business, Lucerne University of Applied Sciences, 6002 Lucerne, Switzerland
| | - Agnieszka Slowik
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, ul. Botaniczna 3, 31-503 Krakow, Poland
| | - Juha E. Jaaskelainen
- Neurosurgery NeuroCenter Kuopio, University Hospital Kuopio, 70210 Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, 70210 Kuopio, Finland
| | - Mikael von und zu Fraunberg
- Neurosurgery NeuroCenter Kuopio, University Hospital Kuopio, 70210 Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, 70210 Kuopio, Finland
| | - Jordi Jiménez-Conde
- Institut Hospital del Mar d’Investigacions Biomèdiques (IMIM) and Hospital del Mar, 08003 Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Institut Hospital del Mar d’Investigacions Biomèdiques (IMIM) and Hospital del Mar, 08003 Barcelona, Spain
| | - Carolina Soriano-Tárraga
- Institut Hospital del Mar d’Investigacions Biomèdiques (IMIM) and Hospital del Mar, 08003 Barcelona, Spain
| | - Iona Y. Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
- MRC Population Health Research Unit, University of Oxford, Oxford OX1 2JD, UK
| | - Robin G. Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
- MRC Population Health Research Unit, University of Oxford, Oxford OX1 2JD, UK
| | | | | | | | | | - Helen Kim
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, Institute for Human Genetics, University of California, San Francisco, CA 94143, USA
| | - Richard Redon
- Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), University Hospital Centre Nantes, University of Nantes, L’institut Du Thorax, 44007 Nantes, France
| | - Nerissa U. Ko
- Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Guy A. Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 0G4, Canada
| | - Antti Lindgren
- Neurosurgery NeuroCenter Kuopio, University Hospital Kuopio, 70210 Kuopio, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, 70210 Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, 70210 Kuopio, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, 00260 Helsinki, Finland
- Neurosurgery Research Group, Biomedicum, 00290 Helsinki, Finland
| | - Hubert Desal
- Department of Neuroradiology, University Hospital of Nantes, 44000 Nantes, France
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Joseph P. Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - David J. Werring
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Ynte M. Ruigrok
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-79-204-4043
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16
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Rezai Jahromi B, Göhre F, Tulamo R, Andrade-Barazarte H. Editorial: Pathophysiology and treatment of fusiform intracranial aneurysms. Front Neurol 2022; 13:893712. [PMID: 36071895 PMCID: PMC9442047 DOI: 10.3389/fneur.2022.893712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Behnam Rezai Jahromi
- Helsinki University Central Hospital, Helsinki, Finland
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Neurosurgery Research Group, Biomedicum, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- *Correspondence: Behnam Rezai Jahromi
| | - Felix Göhre
- Neurochirurgie BG Klinikum Bergmannstrost, Halle, Germany
| | - Riikka Tulamo
- Neurosurgery Research Group, Biomedicum, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hugo Andrade-Barazarte
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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17
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, Josee van Rijn M, Stansby G, Kolh P, Goncalves FB, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ortega MR, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Corrigendum to "European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. [Eur J Vasc Endovasc Surg (2022) 63, 184-267]". Eur J Vasc Endovasc Surg 2022; 64:284-285. [PMID: 35953422 DOI: 10.1016/j.ejvs.2022.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
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18
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Antoniou G, Bastos Gonçalves F, Björck M, Chakfé N, Coscas R, Dias N, Dick F, Kakkos S, Mees B, Resch T, Trimarchi S, Tulamo R, Twine C, Vermassen F, Wanhainen A, Kolh P. European Society for Vascular Surgery Clinical Practice Guideline Development Scheme: An Overview of Evidence Quality Assessment Methods, Evidence to Decision Frameworks, and Reporting Standards in Guideline Development. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Maeseneer M, Kakkos S, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer C, Mosti G, Noppeney T, van Rijn M, Stansby G, ESVS Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst G, Dias N, Hinchliffe R, Koncar I, Lindholt J, Trimarchi S, Tulamo R, Twine C, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye I, Ramirez Ortega M, Ulloa J, Urbanek T, van Rij A, Vuylsteke M. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 178] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
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21
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Huuska N, Netti E, Tulamo R, Lehti S, Jahromi BR, Kovanen PT, Niemelä M. Serum Amyloid A Is Present in Human Saccular Intracranial Aneurysm Walls and Associates With Aneurysm Rupture. J Neuropathol Exp Neurol 2021; 80:966-974. [PMID: 34534311 PMCID: PMC9278718 DOI: 10.1093/jnen/nlab086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Saccular intracranial aneurysm (sIA) rupture leads to a disabling subarachnoid hemorrhage. Chronic inflammation and lipid accumulation in the sIA wall contribute to wall degenerative remodeling that precedes its rupture. A better understanding of the pathobiological process is essential for improved future treatment of patients carrying sIAs. Serum amyloid A (SAA) is an acute-phase protein produced in response to acute and chronic inflammation and tissue damage. Here, we studied the presence and the potential role of SAA in 36 intraoperatively resected sIAs (16 unruptured and 20 ruptured), that had previously been studied by histology and immunohistochemistry. SAA was present in all sIAs, but the extent of immunopositivity varied greatly. SAA immunopositivity correlated with wall degeneration (p = 0.028) and rupture (p = 0.004), with numbers of CD163-positive and CD68-positive macrophages and CD3-positive T lymphocytes (all p < 0.001), and with the expression of myeloperoxidase, matrix metalloproteinase-9, prostaglandin E-2 receptor, and cyclo-oxygenase 2 in the sIA wall. Moreover, SAA positivity correlated with the accumulation of apolipoproteins A-1 and B-100. In conclusion, SAA occurs in the sIA wall and, as an inflammation-related factor, may contribute to the development of a rupture-prone sIA.
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Affiliation(s)
- Nora Huuska
- From the Doctoral Programme in Biomedicine, Doctoral School in Health Sciences, University of Helsinki, Helsinki, Finland.,Neurosurgery Research Group, Biomedicum, Helsinki, Finland
| | - Eliisa Netti
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Riikka Tulamo
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Satu Lehti
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Behnam Rezai Jahromi
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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22
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Tulamo R, Venermo M. Intervention for asymptomatic carotid artery stenosis. Lancet 2021; 398:1025-1027. [PMID: 34469761 DOI: 10.1016/s0140-6736(21)01965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Riikka Tulamo
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, FI-00029 Helsinki, Finland.
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, FI-00029 Helsinki, Finland
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23
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Martins de Souza N, Vikatmaa P, Tulamo R, Venermo M. Etiology and treatment patterns of ruptured extracranial carotid artery aneurysm. J Vasc Surg 2021; 74:2097-2103.e7. [PMID: 34245848 DOI: 10.1016/j.jvs.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Rupture of an extracranial carotid artery aneurysm (ECAA) is a very rare and life-threatening condition. To obtain a comprehensive view of previous and current management of ruptured ECAAs (rECAAs), we analyzed all cases reported since 1940 and two of our own cases. METHODS We performed a comprehensive literature review of reports from the MEDLINE database on rECAAs and included two patients treated in our department. RESULTS A total 58 reports of 74 rECAAs in 74 patients were analyzed. Their mean age was 50 years, and the male/female ratio was 2.2:1. Infection was the most common reported etiology (19 of 74; 26%), followed by connective tissue disorder (13 of 74; 18%), atherosclerosis (9 of 74; 12%), and previous trauma (5 of 74; 7%). For 28 patients (38%), information on the etiology was not available. Of the 74 patients, 24 (32%) had undergone reconstructive surgery, 10 (14%) had undergone endovascular treatment, 17 (23%) had undergone ligation, 2 (3%) had been treated conservatively, and 1 (1%) had died before receiving definite treatment. For 20 patients (27%), information on the treatment received was not available. The complications after reconstruction included carotid blowout (3 of 24 patients; 13%) and cranial nerve deficit (3 of 24 patients; 13%). Two patients (8%) had died of unrelated ECAA causes during long-term follow-up, and one patient (4%) had died of an ECAA-related cause within 30 days. After an endovascular approach, 1 of the 10 patients had developed a cranial nerve deficit. After ligation, five patients (29%) had experienced stroke, three of which were fatal. One conservatively treated patient had experienced no complications and one had died of an ECAA-related cause. CONCLUSIONS The most common reported etiology for rECAA was infection. Reconstructive surgery was the most common approach and was safer than ligation, which carried a high risk of stroke. Endovascular treatment showed promising results, especially for distally located aneurysms; however, the number of patients has remained low.
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Affiliation(s)
- Nicole Martins de Souza
- Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Pirkka Vikatmaa
- Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riikka Tulamo
- Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Niemann A, Voß S, Tulamo R, Weigand S, Preim B, Berg P, Saalfeld S. Complex wall modeling for hemodynamic simulations of intracranial aneurysms based on histologic images. Int J Comput Assist Radiol Surg 2021; 16:597-607. [PMID: 33715047 PMCID: PMC8052238 DOI: 10.1007/s11548-021-02334-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/25/2021] [Indexed: 12/04/2022]
Abstract
Purpose For the evaluation and rupture risk assessment of intracranial aneurysms, clinical, morphological and hemodynamic parameters are analyzed. The reliability of intracranial hemodynamic simulations strongly depends on the underlying models. Due to the missing information about the intracranial vessel wall, the patient-specific wall thickness is often neglected as well as the specific physiological and pathological properties of the vessel wall. Methods In this work, we present a model for structural simulations with patient-specific wall thickness including different tissue types based on postmortem histologic image data. Images of histologic 2D slices from intracranial aneurysms were manually segmented in nine tissue classes. After virtual inflation, they were combined into 3D models. This approach yields multiple 3D models of the inner and outer wall and different tissue parts as a prerequisite for subsequent simulations. Result We presented a pipeline to generate 3D models of aneurysms with respect to the different tissue textures occurring in the wall. First experiments show that including the variance of the tissue in the structural simulation affect the simulation result. Especially at the interfaces between neighboring tissue classes, the larger influence of stiffer components on the stability equilibrium became obvious. Conclusion The presented approach enables the creation of a geometric model with differentiated wall tissue. This information can be used for different applications, like hemodynamic simulations, to increase the modeling accuracy.
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Affiliation(s)
- Annika Niemann
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, D-39106, Magdeburg, Germany.
| | - Samuel Voß
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Riikka Tulamo
- Department of Vascular Surgery, and Neurosurgery Research Group, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Simon Weigand
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Campus Grosshadern, Munich, Germany
| | - Bernhard Preim
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, D-39106, Magdeburg, Germany
| | - Philipp Berg
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Forschungscampus STIMULATE, Magdeburg, Germany
| | - Sylvia Saalfeld
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, D-39106, Magdeburg, Germany.,Forschungscampus STIMULATE, Magdeburg, Germany
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Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, Ten Cate-Hoek AJ, Elalamy I, Enzmann FK, Geroulakos G, Gottsäter A, Hunt BJ, Mansilha A, Nicolaides AN, Sandset PM, Stansby G, Esvs Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Chakfé N, Hinchliffe R, Kolh P, Koncar I, Lindholt JS, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, De Maeseneer MG, Comerota AJ, Gloviczki P, Kruip MJHA, Monreal M, Prandoni P, Vega de Ceniga M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg 2020; 61:9-82. [PMID: 33334670 DOI: 10.1016/j.ejvs.2020.09.023] [Citation(s) in RCA: 229] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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26
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Gonçalves FB, Kakkos SK, Kolh P, Tulamo R, de Ceniga MV, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Corrigendum to 'Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections' [European Journal of Vascular & Endovascular Surgery 59/3 (2020) 339-384]. Eur J Vasc Endovasc Surg 2020; 60:958. [PMID: 32958384 DOI: 10.1016/j.ejvs.2020.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nevzorov I, Tulamo R, Albäck A, Lassila R. COVID-19 and SIC (!). J Vasc Surg 2020; 72:1148-1150. [PMID: 32497749 PMCID: PMC7262520 DOI: 10.1016/j.jvs.2020.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/22/2020] [Indexed: 10/29/2022]
Affiliation(s)
- Ilja Nevzorov
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Riikka Tulamo
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Anders Albäck
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Riitta Lassila
- Coagulation Disorders Unit, University of Helsinki, Departments of Haematology and Clinical Chemistry (HUSLAB Laboratory Services), Comprehensive Cancer Center, Helsinki University Hospital and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University, Faculty of Medicine, Research Program in Oncology, Helsinki, Finland; Aplagon Oy, Helsinki, Finland
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 256] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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29
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Björck M, Earnshaw JJ, Acosta S, Bastos Gonçalves F, Cochennec F, Debus ES, Hinchliffe R, Jongkind V, Koelemay MJW, Menyhei G, Svetlikov AV, Tshomba Y, Van Den Berg JC, Esvs Guidelines Committee, de Borst GJ, Chakfé N, Kakkos SK, Koncar I, Lindholt JS, Tulamo R, Vega de Ceniga M, Vermassen F, Document Reviewers, Boyle JR, Mani K, Azuma N, Choke ETC, Cohnert TU, Fitridge RA, Forbes TL, Hamady MS, Munoz A, Müller-Hülsbeck S, Rai K. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2019; 59:173-218. [PMID: 31899099 DOI: 10.1016/j.ejvs.2019.09.006] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Väärämäki S, Viitala H, Uurto I, Björkman P, Tulamo R, Aho P, Laukontaus S, Laine M, Suominen V, Venermo M. Prophylactic Inferior Mesenteric Artery (IMA) Embolization is Unnecessary Before Endovascular Aneurysm Repair (EVAR). Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rakemaa L, Laukontaus SJ, Aho PS, Tulamo R, Laine M, Venermo M. Ultrasound Surveillance is Feasible After Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Barreiro KA, Tulamo R, Jouppila A, Albäck A, Lassila R. Novel Locally Acting Dual Antiplatelet and Anticoagulant (APAC) Targets Multiple Sites of Vascular Injury in an Experimental Porcine Model. Eur J Vasc Endovasc Surg 2019; 58:903-911. [PMID: 31708337 DOI: 10.1016/j.ejvs.2019.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Vascular binding of dual antiplatelet and anticoagulant (APAC) was assessed in surgically created femoral arteriovenous fistula (AVF) and iliac and carotid artery injury in porcine models. METHODS Three models of collagen exposing injury were used: 1) femoral AVF, 2) in vivo iliac and carotid artery balloon angioplasty injury, and 3) in vitro femoral artery endothelial denudation injury. Biotinylated APAC (0.5 mg/mL) was incubated with the injury site before releasing blood flow. APAC, von Willebrand factor (vWF), laminin, platelet endothelial cell adhesion molecule 1 (PECAM-1), and podocalyxin were detected in histological sections using immunofluorescence and confocal microscopy and Manders' co-localisation coefficient (M1). RESULTS APAC bound to AVF at anastomosis and to both in vivo and in vitro injured arteries. APAC co-localised with matrix vWF (M1 ≥ 0.66) and laminin (M1 ≥ 0.60), but less so if endothelial PECAM-1 or podocalyxin was present (M1 ≤ 0.25). APAC targeted and penetrated the injured vessel wall, especially the AVF vein. CONCLUSIONS APAC, compatible with its high negative charge, rapidly targets injured vessels co-localizing with matrix vWF and laminin, but not with endothelial PECAM-1 and podocalyxin. This localising feature may have potential antithrombotic implications for vascular interventions.
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Affiliation(s)
- Karina A Barreiro
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland; Aplagon Oy, Helsinki, Finland
| | - Riikka Tulamo
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Annukka Jouppila
- Helsinki University Hospital Clinical Research Institute, Helsinki, Finland
| | - Anders Albäck
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Riitta Lassila
- Coagulation Disorders Unit, University of Helsinki, Departments of Haematology and Clinical Chemistry (HUSLAB Laboratory Services), Comprehensive Cancer Center, Helsinki University Hospital and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Helsinki University, Faculty of Medicine, Research Program in Oncology, Helsinki, Finland; Aplagon Oy, Helsinki, Finland.
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33
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Niemann A, Weigand S, Hoffmann T, Skalej M, Tulamo R, Preim B, Saalfeld S. Interactive exploration of a 3D intracranial aneurysm wall model extracted from histologic slices. Int J Comput Assist Radiol Surg 2019; 15:99-107. [PMID: 31705419 DOI: 10.1007/s11548-019-02083-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/18/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Currently no detailed in vivo imaging of the intracranial vessel wall exists. Ex vivo histologic images can provide information about the intracranial aneurysm (IA) wall composition that is useful for the understanding of IA development and rupture risk. For a 3D analysis, the 2D histologic slices must be incorporated in a 3D model which can be used for a spatial evaluation of the IA's morphology, including analysis of the IA neck. METHODS In 2D images of histologic slices, different wall layers were manually segmented and a 3D model was generated. The nuclei were automatically detected and classified as round or elongated, and a neural network-based wall type classification was performed. The information was combined in a software prototype visualization providing a unique view of the wall characteristics of an IA and allowing interactive exploration. Furthermore, the heterogeneity (as variance of the wall thickness) of the wall was evaluated. RESULT A 3D model correctly representing the histologic data was reconstructed. The visualization integrating wall information was perceived as useful by a medical expert. The classification produces a plausible result. CONCLUSION The usage of histologic images allows to create a 3D model with new information about the aneurysm wall. The model provides information about the wall thickness, its heterogeneity and, when performed on cadaveric samples, includes information about the transition between IA neck and sac.
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Affiliation(s)
- Annika Niemann
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.
| | - Simon Weigand
- Ludwig-Maximilians-Universität Klinikum, Munich, Germany
| | | | | | - Riikka Tulamo
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Bernhard Preim
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Sylvia Saalfeld
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.,Research Campus STIMULATE, Magdeburg, Germany
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Kurtelius A, Väntti N, Rezai Jahromi B, Tähtinen O, Manninen H, Koskenvuo J, Tulamo R, Kotikoski S, Nurmonen H, Kämäräinen OP, Huttunen T, Huttunen J, von Und Zu Fraunberg M, Koivisto T, Jääskeläinen JE, Lindgren AE. Association of Intracranial Aneurysms With Aortic Aneurysms in 125 Patients With Fusiform and 4253 Patients With Saccular Intracranial Aneurysms and Their Family Members and Population Controls. J Am Heart Assoc 2019; 8:e013277. [PMID: 31538843 PMCID: PMC6818001 DOI: 10.1161/jaha.119.013277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Varying degrees of co‐occurrence of intracranial aneurysms (IA) and aortic aneurysms (AA) have been reported. We sought to compare the risk for AA in fusiform intracranial aneurysms (fIA) and saccular intracranial aneurysms (sIA) disease and evaluate possible genetic connection between the fIA disease and AAs. Additionally, the characteristics and aneurysms of the fIA and sIA patients were compared. Methods and Results The Kuopio Intracranial Aneurysm Database includes all 4253 sIA and 125 fIA patients from its Eastern Finnish catchment population, and 13 009 matched population controls and 18 455 first‐degree relatives to the IA patients were identified, and the Finnish national registers were used to identify the individuals with AA. A total of 33 fIA patients were studied using an exomic gene panel of 37 genes associated with AAs. Seventeen (14.4%) fIA patients and 48 (1.2%) sIA patients had a diagnosis of AA. Both fIA and sIA patients had AAs significantly more often than their controls (1.2% and 0.5%) or relatives (0.9% and 0.3%). In a competing risks Cox regression model, the presence of fIA was the strongest risk factor for AA (subdistribution hazard ratio 7.6, 95% CI 3.9–14.9, P<0.0005). One likely pathogenic variant in COL5A2 and 3 variants of unknown significance were identified in MYH11,COL11A1, and FBN1 in 4 fIA patients. Conclusions The prevalence of AAs is increased slightly in sIA patients and significantly in fIA patients. fIA patients are older and have more comorbid diseases than sIA patients but this alone does not explain their clinically significant AA risk.
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Affiliation(s)
- Arttu Kurtelius
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Nelli Väntti
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery Helsinki University Hospital University of Helsinki Finland
| | - Olli Tähtinen
- Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,Department of Clinical Radiology Kuopio University Hospital Kuopio Finland
| | - Hannu Manninen
- Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,Department of Clinical Radiology Kuopio University Hospital Kuopio Finland
| | - Juha Koskenvuo
- Blueprint Genetics Helsinki Finland.,Department of Clinical Physiology and Nuclear Medicine Turku University Hospital Turku Finland
| | - Riikka Tulamo
- Department of Vascular Surgery Helsinki University Hospital University of Helsinki Finland
| | - Satu Kotikoski
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Heidi Nurmonen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Olli-Pekka Kämäräinen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Terhi Huttunen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Jukka Huttunen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Timo Koivisto
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Juha E Jääskeläinen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Antti E Lindgren
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
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Gade PS, Tulamo R, Lee KW, Mut F, Ollikainen E, Chuang CY, Jae Chung B, Niemelä M, Rezai Jahromi B, Aziz K, Yu A, Charbel FT, Amin-Hanjani S, Frösen J, Cebral JR, Robertson AM. Calcification in Human Intracranial Aneurysms Is Highly Prevalent and Displays Both Atherosclerotic and Nonatherosclerotic Types. Arterioscler Thromb Vasc Biol 2019; 39:2157-2167. [PMID: 31462093 PMCID: PMC6911659 DOI: 10.1161/atvbaha.119.312922] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although the clinical and biological importance of calcification is well recognized for the extracerebral vasculature, its role in cerebral vascular disease, particularly, intracranial aneurysms (IAs), remains poorly understood. Extracerebrally, 2 distinct mechanisms drive calcification, a nonatherosclerotic, rapid mineralization in the media and a slower, inflammation driven, atherosclerotic mechanism in the intima. This study aims to determine the prevalence, distribution, and type (atherosclerotic, nonatherosclerotic) of calcification in IAs and assess differences in occurrence between ruptured and unruptured IAs. Approach and Results: Sixty-five 65 IA specimens (48 unruptured, 17 ruptured) were resected perioperatively. Calcification and lipid pools were analyzed nondestructively in intact samples using high resolution (0.35 μm) microcomputed tomography. Calcification is highly prevalent (78%) appearing as micro (<500 µm), meso (500 µm-1 mm), and macro (>1 mm) calcifications. Calcification manifests in IAs as both nonatherosclerotic (calcification distinct from lipid pools) and atherosclerotic (calcification in the presence of lipid pools) with 3 wall types: Type I-only calcification, no lipid pools (20/51, 39%), Type II-calcification and lipid pools, not colocalized (19/51, 37%), Type III-calcification colocalized with lipid pools (12/51, 24%). Ruptured IAs either had no calcifications or had nonatherosclerotic micro- or meso-calcifications (Type I or II), without macro-calcifications. CONCLUSIONS Calcification in IAs is substantially more prevalent than previously reported and presents as both nonatherosclerotic and atherosclerotic types. Notably, ruptured aneurysms had only nonatherosclerotic calcification, had significantly lower calcification fraction, and did not contain macrocalcifications. Improved understanding of the role of calcification in IA pathology should lead to new therapeutic targets.
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Affiliation(s)
- Piyusha S Gade
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA
| | - Riikka Tulamo
- Department of Vascular Surgery (R.T.), Helsinki University Hospital, University of Helsinki, Finland
| | - Kee-Won Lee
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, VA (F.M., J.R.C.)
| | - Eliisa Ollikainen
- Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA.,Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Chih-Yuan Chuang
- Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, NJ (B.J.C.)
| | - Mika Niemelä
- Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Khaled Aziz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA (K.A., A.Y.)
| | - Alexander Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA (K.A., A.Y.)
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago (F.T.C., S.A.-H.)
| | | | - Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital, Finland (J.F.)
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, VA (F.M., J.R.C.)
| | - Anne M Robertson
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA.,Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA
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Ollikainen E, Tulamo R, Lehti S, Hernesniemi J, Niemelä M, Kovanen PT, Frösen J. Myeloperoxidase Associates With Degenerative Remodeling and Rupture of the Saccular Intracranial Aneurysm Wall. J Neuropathol Exp Neurol 2019; 77:461-468. [PMID: 29718300 DOI: 10.1093/jnen/nly028] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rupture of a saccular intracranial aneurysm (sIA) is often fatal. Thus, early detection of rupture-prone sIAs is vital. Myeloperoxidase (MPO), derived mainly from neutrophils, associates with sIA rupture, and therefore its role in sIA pathogenesis warrants further studies. We analyzed MPO and its association with other histological markers in 36 (16 unruptured and 20 ruptured) sIA samples by immunohistochemistry. MPO was present in all studied sIAs, and its expression associated with wall inflammatory cell infiltrations (r = 0.50, 0.63, and 0.75, all p ≤ 0.002), degenerative remodeling (p = 0.002) and rupture (p = 0.003). MPO associated strongly with the presence of organized luminal thrombi (p < 0.001), which also stained positive for MPO. Polymorphonuclear MPO+ cells were detected in the sIA walls, indicating neutrophils as MPO-source. MPO correlated strongly with accumulation of oxidized lipids (r = 0.67, p < 0.001) and loss of smooth muscle cells (r = -0.68, p < 0.001), suggesting that MPO is a relevant source of oxidative stress leading to cell death in the sIA wall. Furthermore, MPO associated with erythrocyte fragmentation (r = 0.74, p < 0.001) and iron deposition (p = 0.041), 2 outcomes known to amplify MPO-dependent oxidative stress. Taken together, these results suggest that MPO associates with degenerative remodeling predisposing to sIA wall rupture and may serve as a biomarker of a rupture-prone sIA wall.
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Affiliation(s)
- Eliisa Ollikainen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Wihuri Research Institute, Biomedicum, Helsinki, Finland
| | - Riikka Tulamo
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Satu Lehti
- Wihuri Research Institute, Biomedicum, Helsinki, Finland
| | - Juha Hernesniemi
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Neurosurgery, Henan Province People's Hospital, Zhengzhou, China
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Juhana Frösen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Neurosurgery, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
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37
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Grootes I, Barrett JK, Ulug P, Rohlffs F, Laukontaus SJ, Tulamo R, Venermo M, Greenhalgh RM, Sweeting MJ. Predicting risk of rupture and rupture-preventing reinterventions following endovascular abdominal aortic aneurysm repair. Br J Surg 2019; 105:1294-1304. [PMID: 30133767 PMCID: PMC6175165 DOI: 10.1002/bjs.10964] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/22/2018] [Accepted: 06/30/2018] [Indexed: 11/12/2022]
Abstract
Background Clinical and imaging surveillance practices following endovascular aneurysm repair (EVAR) for intact abdominal aortic aneurysm (AAA) vary considerably and compliance with recommended lifelong surveillance is poor. The aim of this study was to develop a dynamic prognostic model to enable stratification of patients at risk of future secondary aortic rupture or the need for intervention to prevent rupture (rupture‐preventing reintervention) to enable the development of personalized surveillance intervals. Methods Baseline data and repeat measurements of postoperative aneurysm sac diameter from the EVAR‐1 and EVAR‐2 trials were used to develop the model, with external validation in a cohort from a single‐centre vascular database. Longitudinal mixed‐effects models were fitted to trajectories of sac diameter, and model‐predicted sac diameter and rate of growth were used in prognostic Cox proportional hazards models. Results Some 785 patients from the EVAR trials were included, of whom 155 (19·7 per cent) experienced at least one rupture or required a rupture‐preventing reintervention during follow‐up. An increased risk was associated with preoperative AAA size, rate of sac growth and the number of previously detected complications. A prognostic model using predicted sac growth alone had good discrimination at 2 years (C‐index 0·68), 3 years (C‐index 0·72) and 5 years (C‐index 0·75) after operation and had excellent external validation (C‐index 0·76–0·79). More than 5 years after operation, growth rates above 1 mm/year had a sensitivity of over 80 per cent and specificity over 50 per cent in identifying events occurring within 2 years. Conclusion Secondary sac growth is an important predictor of rupture or rupture‐preventing reintervention to enable the development of personalized surveillance intervals. A dynamic prognostic model has the potential to tailor surveillance by identifying a large proportion of patients who may require less intensive follow‐up. Potential to tailor surveillance
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Affiliation(s)
- I Grootes
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - J K Barrett
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - P Ulug
- Vascular Surgery Research Group, Imperial College London, Charing Cross Hospital, London, UK
| | - F Rohlffs
- Vascular Surgery Research Group, Imperial College London, Charing Cross Hospital, London, UK
| | - S J Laukontaus
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - R Tulamo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - R M Greenhalgh
- Vascular Surgery Research Group, Imperial College London, Charing Cross Hospital, London, UK
| | - M J Sweeting
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
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Cebral JR, Detmer F, Chung BJ, Choque-Velasquez J, Rezai B, Lehto H, Tulamo R, Hernesniemi J, Niemela M, Yu A, Williamson R, Aziz K, Shakur S, Amin-Hanjani S, Charbel F, Tobe Y, Robertson A, Frösen J. Local Hemodynamic Conditions Associated with Focal Changes in the Intracranial Aneurysm Wall. AJNR Am J Neuroradiol 2019; 40:510-516. [PMID: 30733253 DOI: 10.3174/ajnr.a5970] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysm hemodynamics has been associated with wall histology and inflammation. We investigated associations between local hemodynamics and focal wall changes visible intraoperatively. MATERIALS AND METHODS Computational fluid dynamics models were constructed from 3D images of 65 aneurysms treated surgically. Aneurysm regions with different visual appearances were identified in intraoperative videos: 1) "atherosclerotic" (yellow), 2) "hyperplastic" (white), 3) "thin" (red), 4) rupture site, and 5) "normal" (similar to parent artery), They were marked on 3D reconstructions. Regional hemodynamics was characterized by the following: wall shear stress, oscillatory shear index, relative residence time, wall shear stress gradient and divergence, gradient oscillatory number, and dynamic pressure; these were compared using the Mann-Whitney test. RESULTS Hyperplastic regions had lower average wall shear stress (P = .005) and pressure (P = .009) than normal regions. Flow conditions in atherosclerotic and hyperplastic regions were similar but had higher average relative residence time (P = .03) and oscillatory shear index (P = .04) than thin regions. Hyperplastic regions also had a higher average gradient oscillatory number (P = .002) than thin regions. Thin regions had lower average relative residence time (P < .001), oscillatory shear index (P = .006), and gradient oscillatory number (P < .001) than normal regions, and higher average wall shear stress (P = .006) and pressure (P = .009) than hyperplastic regions. Thin regions tended to be aligned with the flow stream, while atherosclerotic and hyperplastic regions tended to be aligned with recirculation zones. CONCLUSIONS Local hemodynamics is associated with visible focal wall changes. Slow swirling flow with low and oscillatory wall shear stress was associated with atherosclerotic and hyperplastic changes. High flow conditions prevalent in regions near the flow impingement site characterized by higher and less oscillatory wall shear stress were associated with local "thinning" of the wall.
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Affiliation(s)
- J R Cebral
- From the Department of Bioengineering (J.R.C., F.D., B.J.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - F Detmer
- From the Department of Bioengineering (J.R.C., F.D., B.J.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - B J Chung
- From the Department of Bioengineering (J.R.C., F.D., B.J.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - J Choque-Velasquez
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B Rezai
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - H Lehto
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - R Tulamo
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Vascular Surgery (R.T.), Helsinki University Central Hospital, Helsinki, Finland
| | - J Hernesniemi
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - M Niemela
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - A Yu
- Department of Neurosurgery (A.Y., R.W., K.A.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - R Williamson
- Department of Neurosurgery (A.Y., R.W., K.A.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - K Aziz
- Department of Neurosurgery (A.Y., R.W., K.A.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - S Shakur
- Department of Neurosurgery (S.S., S.A.-H., F.C.), University of Illinois at Chicago, Chicago, Illinois
| | - S Amin-Hanjani
- Department of Neurosurgery (S.S., S.A.-H., F.C.), University of Illinois at Chicago, Chicago, Illinois
| | - F Charbel
- Department of Neurosurgery (S.S., S.A.-H., F.C.), University of Illinois at Chicago, Chicago, Illinois
| | - Y Tobe
- Mechanical Engineering and Materials Science and Department of Bioengineering (Y.T., A.R.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - A Robertson
- Mechanical Engineering and Materials Science and Department of Bioengineering (Y.T., A.R.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Frösen
- Hemorrhagic Brain Pathology Research Group (J.F.), Neurocenter, Kuopio University Hospital, Kuopio, Finland
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Jouppila A, Barreiro K, Tulamo R, Alback A, Lemponen M, Lassila R. P6559APAC, a dual antiplatelet and anticoagulant, attenuates platelet procoagulant activity and localizes to extravascular matrix during vascular injury. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Jouppila
- Helsinki University Hospital Research Institute, Helsinki, Finland
| | - K Barreiro
- Institute for Molecular Medicine Finland FIMM, Helsinki University, Helsinki, Finland
| | - R Tulamo
- Helsinki University Hospital and University of Helsinki, Department of Vascular Surgery, Helsinki, Finland
| | - A Alback
- Helsinki University Hospital and University of Helsinki, Department of Vascular Surgery, Helsinki, Finland
| | - M Lemponen
- Hospital District of Helsinki and Uusimaa, Laboratory Services HUSLAB, Helsinki, Finland
| | - R Lassila
- Helsinki University Hospital and University of Helsinki, Coagulation Disorders Unit, Hematology and Clinical Chemistry, Comprehensive Cancer Center, Helsinki, Finland
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40
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Tulamo R, Frösen J, Hernesniemi J, Niemelä M. Inflammatory changes in the aneurysm wall: a review. J Neurointerv Surg 2018; 10:i58-i67. [DOI: 10.1136/jnis.2009.002055.rep] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/17/2009] [Accepted: 12/18/2009] [Indexed: 02/06/2023]
Abstract
Rupture of a saccular intracranial artery aneurysm (IA) causes subarachnoid hemorrhage, a significant cause of stroke and death. The current treatment options, endovascular coiling and clipping, are invasive and somewhat risky. Since only some IAs rupture, those IAs at risk for rupture should be identified. However, to improve the imaging of rupture-prone IAs and improve IA treatment, IA wall pathobiology requires more thorough knowledge. Chronic inflammation has become understood as an important phenomenon in IA wall pathobiology, featuring inflammatory cell infiltration as well as proliferative and fibrotic remodulatory responses. We review the literature on what is known about inflammation in the IA wall and also review the probable mechanisms of how inflammation would result in the degenerative changes that ultimately lead to IA wall rupture. We also discuss current options in imaging inflammation and how knowledge of inflammation in IA walls may improve IA treatment.
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41
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Ollikainen E, Tulamo R, Kaitainen S, Honkanen P, Lehti S, Liimatainen T, Hernesniemi J, Niemelä M, Kovanen PT, Frösen J. Macrophage Infiltration in the Saccular Intracranial Aneurysm Wall as a Response to Locally Lysed Erythrocytes That Promote Degeneration. J Neuropathol Exp Neurol 2018; 77:890-903. [DOI: 10.1093/jnen/nly068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Eliisa Ollikainen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Wihuri Research Institute, Biomedicum, Helsinki, Finland
| | - Riikka Tulamo
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Department of Vascular Surgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Petri Honkanen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
| | - Satu Lehti
- Wihuri Research Institute, Biomedicum, Helsinki, Finland
| | - Timo Liimatainen
- Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Hernesniemi
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Department of Neurosurgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
- Department of Neurosurgery, Henan Province People's Hospital, Zhengzhou, China
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Department of Neurosurgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Juhana Frösen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Department of Neurosurgery
- Hemorrhagic Brain Pathology Research Group
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42
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Cebral J, Ollikainen E, Chung BJ, Mut F, Sippola V, Jahromi BR, Tulamo R, Hernesniemi J, Niemelä M, Robertson A, Frösen J. Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall. AJNR Am J Neuroradiol 2016; 38:119-126. [PMID: 27686488 DOI: 10.3174/ajnr.a4951] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall. MATERIALS AND METHODS Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies. RESULTS More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration (P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress (P = .018), higher vorticity (P = .046), higher viscous dissipation (P = .046), and high shear rate (P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium (P = .034) and the presence of organized luminal thrombosis (P = .018), though overall organized thrombosis was associated with low minimum wall shear stress (P = .034) and not with the flow conditions associated with inflammation. CONCLUSIONS Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.
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Affiliation(s)
- J Cebral
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - E Ollikainen
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B J Chung
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - F Mut
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - V Sippola
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B R Jahromi
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - R Tulamo
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Vascular Surgery (R.T.), Helsinki University Central Hospital, Helsinki, Finland
| | - J Hernesniemi
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - M Niemelä
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - A Robertson
- Mechanical Engineering and Materials Science and Department of Bioengineering (A.R.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Frösen
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland .,Department of Neurosurgery and Hemorrhagic Brain Pathology Research Group (J.F.), Neurocenter, Kuopio University Hospital, Kuopio, Finland
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43
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Ollikainen E, Tulamo R, Lehti S, Lee-Rueckert M, Hernesniemi J, Niemelä M, Ylä-Herttuala S, Kovanen PT, Frösen J. Smooth Muscle Cell Foam Cell Formation, Apolipoproteins, and ABCA1 in Intracranial Aneurysms: Implications for Lipid Accumulation as a Promoter of Aneurysm Wall Rupture. J Neuropathol Exp Neurol 2016; 75:689-99. [PMID: 27283327 DOI: 10.1093/jnen/nlw041] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Saccular intracranial aneurysm (sIA) aneurysm causes intracranial hemorrhages that are associated with high mortality. Lipid accumulation and chronic inflammation occur in the sIA wall. A major mechanism for lipid clearance from arteries is adenosine triphosphate-binding cassette A1 (ABCA1)-mediated lipid efflux from foam cells to apolipoprotein A-I (apoA-I). We investigated the association of wall degeneration, inflammation, and lipid-related parameters in tissue samples of 16 unruptured and 20 ruptured sIAs using histology and immunohistochemistry. Intracellular lipid accumulation was associated with wall remodeling (p = 0.005) and rupture (p = 0.020). Foam cell formation was observed in smooth muscle cells, in addition to CD68- and CD163-positive macrophages. Macrophage infiltration correlated with intracellular lipid accumulation and apolipoproteins, including apoA-I. ApoA-I correlated with markers of lipid accumulation and wall degeneration (p = 0.01). ApoA-I-positive staining colocalized with ABCA1-positive cells particularly in sIAs with high number of smooth muscle cells (p = 0.003); absence of such colocalization was associated with wall degeneration (p = 0.017). Known clinical risk factors for sIA rupture correlated inversely with apoA-I. We conclude that lipid accumulation associates with sIA wall degeneration and risk of rupture, possibly via formation of foam cells and subsequent loss of mural cells. Reduced removal of lipids from the sIA wall via ABCA1-apoA-I pathway may contribute to this process.
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Affiliation(s)
- Eliisa Ollikainen
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Riikka Tulamo
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Satu Lehti
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Miriam Lee-Rueckert
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Juha Hernesniemi
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Mika Niemelä
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Seppo Ylä-Herttuala
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Petri T Kovanen
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Juhana Frösen
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
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Cebral J, Chung B, Mut F, Robertson A, Tulamo R, Frosen J. Abstract 13: Wall Shear Stress Associated to Intracranial Aneurysm Wall Inflammation. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Inflammation has been proposed as a possible mechanism involved in the degradation and weakening of the walls of intracranial aneurysms.
Hypothesis:
Abnormal wall shear stress (WSS) levels induce wall inflammation which then affects the wall structure and mechanics
Methods:
A total of 20 aneurysms which underwent surgical clipping were studied. Patient-specific computational fluid dynamics models were constructed from pre-surgical CTA images. Numerical simulations were carried out using pulsatile flows. After clipping the aneurysm, a tissue sample was resected from the dome and analyzed histologically with CD45 to search for evidence of wall inflammation. For analysis, the aneurysm series was divided in two different manners. First, aneurysms were classified into an “inflammation” group if the number of CD45+ cells was larger than the median of CD45+ cells in the entire sample of 20 aneurysms; otherwise they were classified as “no-inflammation”. Hemodynamic variables were then statistically compared between these two groups. Secondly, aneurysms were subdivided into three groups according to their mean WSS: 1) “low WSS” if WSS<0.5*median(WSS), 2) “high WSS” if WSS>2*median(WSS), and 3) “mid WSS” otherwise. The numbers of CD45+ cells in each group were then statistically compared.
Results:
Aneurysms in the “inflammation” group had significantly larger mean WSS (p=0.018), shear rate (p=0.015), vorticity (p=0.018), and viscous dissipation (p=0.015) than aneurysms in the “no-inflammation” group. Conversely, aneurysms in the “high WSS” group had significantly larger numbers of CD45+ cells (p=0.0046) than the “mid WSS” and “low WSS” groups. Interestingly, aneurysms with stable flow patterns also tended to have larger numbers of inflammatory cells (p=0.040) than aneurysms with unstable flows.
Conclusion:
These preliminary results suggest that there is a connection between intra-aneurysmal flow characteristics and wall inflammation in cerebral aneurysms. In particular, inflamed walls seem to be associated with higher levels of wall shear stress.
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Affiliation(s)
| | | | | | | | - Riikka Tulamo
- Biomedicum and Helsinki Univ Central Hosp, Helsinki, Finland
| | - Juhana Frosen
- Biomedicum and Helsinki Univ Central Hosp, Helsinki, Finland
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Affiliation(s)
- Riikka Tulamo
- Neurosurgery Research Group, Biomedicum Helsinki, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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Frösen J, Tulamo R, Heikura T, Sammalkorpi S, Niemelä M, Hernesniemi J, Levonen AL, Hörkkö S, Ylä-Herttuala S. Lipid accumulation, lipid oxidation, and low plasma levels of acquired antibodies against oxidized lipids associate with degeneration and rupture of the intracranial aneurysm wall. Acta Neuropathol Commun 2013; 1:71. [PMID: 24252658 PMCID: PMC3893371 DOI: 10.1186/2051-5960-1-71] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/18/2013] [Indexed: 12/02/2022] Open
Abstract
Background Rupture of a saccular intracranial aneurysm (sIA) causes an often fatal subarachnoid hemorrhage (SAH). Why some sIAs rupture remains unknown. Since sIA walls bear some histological similarities with early atherosclerotic lesions, we hypothesized that accumulation and oxidation of lipids might occur in the sIA wall and might associate with sIA wall degeneration. Tissue samples from sIA fundi (n = 54) were studied with histochemistry and a panel of previously characterized antibodies for epitopes of oxidized LDL (OxLDL). Plasma samples from sIA carriers (n = 125) were studied with ELISA and EIA for IgG and IgM -antibodies against a panel of OxLDL epitopes. Results Lipid accumulation, foam cells, and oxidized lipids were found both in unruptured and ruptured sIA walls. Lipid accumulation associated with wall degeneration (P < 0.001), as did the expression of adipophilin, a marker of lipid ingestion by cells. Lipid accumulation associated also with loss of mural cells (P < 0.001), as did the accumulation of OxLDL (P < 0.001). Plasma IgG antibody titers against OxLDL or malondialdehyde modified LDL were higher in patients with unruptured sIAs than in patients with aneurysmal SAH (P ≤ 0.001). A trend but not statistically significant differences were found in plasma IgM antibodies against oxidized lipids. Conclusions Accumulation of lipids and their oxidation in the sIA wall associates with the degeneration of the sIA wall. Acquired immunity against oxidized lipid epitopes may be protective of lipid associated sIA wall degeneration, but warrants further studies.
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Laaksamo E, Tulamo R, Liiman A, Baumann M, Friedlander RM, Hernesniemi J, Kangasniemi M, Niemelä M, Laakso A, Frösen J. Oxidative Stress Is Associated With Cell Death, Wall Degradation, and Increased Risk of Rupture of the Intracranial Aneurysm Wall. Neurosurgery 2012; 72:109-17. [DOI: 10.1227/neu.0b013e3182770e8c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The cause of rupture of intracranial aneurysms (IA) is not well understood. We previously demonstrated that loss of cells from the IA wall is associated with wall degeneration and rupture.
OBJECTIVE:
To investigate the mechanisms mediating cell death in the IA wall.
METHODS:
Snap-frozen tissue samples from aneurysm fundi were studied with terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining and immunostaining (14 unruptured and 20 ruptured), as well as with Western blot (12 unruptured and 12 ruptured).
RESULTS:
Ruptured IA walls had more TUNEL-positive cells than unruptured walls (P < .001). Few cells positive for cleaved caspase-3 were detected. Cleaved caspase-9 (intrinsic activation of apoptosis) was significantly increased in ruptured IA walls, whereas cleaved caspase-8 (extrinsic activation of apoptosis) was not detected. Increased expression of hemeoxygenase-1, a marker for oxidative stress, was associated with IA wall degeneration and rupture.
CONCLUSION:
Our results show that programmed cell death is activated in the IA wall via the intrinsic pathway. High oxidative stress in the IA wall is probably a significant cause of the intrinsic activation of cell death.
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Affiliation(s)
| | | | - Arto Liiman
- Neurosurgery Research Group, Biomedicum Helsinki,
| | - Marc Baumann
- Protein Chemistry/Proteomics Laboratory, Institute of Biomedicine, University of Helsinki, Helsinki, Finland
| | - Robert M. Friedlander
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Neuroapoptosis Laboratory, Harvard Medical School, Boston, Massachusetts
| | - Juha Hernesniemi
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Marko Kangasniemi
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center), Helsinki, Finland
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Aki Laakso
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juhana Frösen
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Neuroapoptosis Laboratory, Harvard Medical School, Boston, Massachusetts
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Laaksamo E, Ramachandran M, Frösen J, Tulamo R, Baumann M, Friedlander RM, Harbaugh RE, Hernesniemi J, Niemelä M, Raghavan ML, Laakso A. Intracellular signaling pathways and size, shape, and rupture history of human intracranial aneurysms. Neurosurgery 2012; 70:1565-72; discussion 1572-3. [PMID: 22278358 DOI: 10.1227/neu.0b013e31824c057e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Size and morphological features are associated with intracranial aneurysm (IA) rupture. The cellular mechanisms of IA development and rupture are poorly known. OBJECTIVE We studied the expression and phosphorylation of different intracellular signaling molecules in the IA wall compared with IA morphological features to understand better the cellular pathways involved in IA development and wall degeneration. METHODS Nine ruptured and 17 unruptured human IA samples were collected intraoperatively. The expression levels and phosphorylation state of 3 mitogen-activated protein kinases (c-Jun N-terminal kinase [JNK], p38, extracellular signal-regulated kinase [ERK]), Bcl-2 antagonist of cell death (Bad), mammalian target of rapamycin (mTOR), cyclic AMP response element binding protein (CREB), and Akt were determined by Western blotting. The localization of signaling proteins was determined by immunofluorescence. From 3-dimensional segmentation of computed tomography angiographic data, size and shape indexes were calculated. RESULTS We found a 5-fold difference in phospho-Bad levels between ruptured and unruptured IAs. Phospho-mTOR was downregulated 2.5-fold in ruptured IAs. Phospho-p54 JNK, phospho-p38, and phospho-Akt levels correlated positively with IA size. Phospho-CREB levels were significantly associated with nonsphericity and ellipticity indexes. Phospho-Akt and phospho-p38 correlated negatively with undulation index. CONCLUSION The signaling pathway profile (apoptosis, cell proliferation, stress signaling) differs between ruptured and unruptured IAs and is associated with IA geometry. Our results increase the knowledge of IA development and wall degeneration.
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Affiliation(s)
- Elisa Laaksamo
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
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Frösen J, Tulamo R, Paetau A, Laaksamo E, Korja M, Laakso A, Niemelä M, Hernesniemi J. Saccular intracranial aneurysm: pathology and mechanisms. Acta Neuropathol 2012; 123:773-86. [PMID: 22249619 DOI: 10.1007/s00401-011-0939-3] [Citation(s) in RCA: 296] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 12/22/2011] [Accepted: 12/31/2011] [Indexed: 01/06/2023]
Abstract
Saccular intracranial aneurysms (sIA) are pouch-like pathological dilatations of intracranial arteries that develop when the cerebral artery wall becomes too weak to resist hemodynamic pressure and distends. Some sIAs remain stable over time, but in others mural cells die, the matrix degenerates, and eventually the wall ruptures, causing life-threatening hemorrhage. The wall of unruptured sIAs is characterized by myointimal hyperplasia and organizing thrombus, whereas that of ruptured sIAs is characterized by a decellularized, degenerated matrix and a poorly organized luminal thrombus. Cell-mediated and humoral inflammatory reaction is seen in both, but inflammation is clearly associated with degenerated and ruptured walls. Inflammation, however, seems to be a reaction to the ongoing degenerative processes, rather than the cause. Current data suggest that the loss of mural cells and wall degeneration are related to impaired endothelial function and high oxidative stress, caused in part by luminal thrombosis. The aberrant flow conditions caused by sIA geometry are the likely cause of the endothelial dysfunction, which results in accumulation of cytotoxic and pro-inflammatory substances into the sIA wall, as well as thrombus formation. This may start the processes that eventually can lead to the decellularized and degenerated sIA wall that is prone to rupture.
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Affiliation(s)
- Juhana Frösen
- Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.
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